VIDEO: Surgeon rescues eyes from devastating consequences of angle-supported IOLs

This video shows the case of a 34-year-old woman who, 12 years after implantation of angle-supported phakic IOLs developed cataract, iris atrophy, pupil deformation and glaucoma in both eyes. Camille Budo, MD, OSN Europe Edition Board Member, took care of this patient who was referred to him. He removed the phakic IOL, performed cataract surgery with IOL implantation and also implanted an iris prosthesis, allowing the patient to recover vision as well as aesthetic appearance.

Surgery was performed under topical anesthesia. Two paracenteses and one mini-incision were performed, and a dispersive ophthalmic viscosurgical device was injected.

“Removing the phakic IOL was difficult because of the synechiae formation around the loops in the angle. I cut the loops in more than one place and even left small parts in place because they were too tightly embedded in the tissue,” Budo said.

Then, he cut some iris fibers, performed a capsulorrhexis, removed the cataract by phacoemulsification and irrigation-aspiration, and implanted an AcrySof IOL (Alcon) in the capsular bag.

At this stage, Budo implanted the iris prosthesis, a HumanOptics ArtificialIris.

“This iris prosthesis can be implanted in the posterior chamber or in the capsular bag, and I decided to go for the first option. I reopened the incision, inserted the iris, let it unfold and placed it in the posterior chamber. There is no need to enlarge the incision because this prosthesis is made of very flexible silicone. This characteristic, at the same time, makes implantation a little tricky, and you need a gentle but firm and precise hand,” Budo said.

Another advantage of this implant, besides foldability, is that it comes in different colors and the effect is extremely natural.

Budo operated on both eyes at an interval of about 3 months. The patient is happy and has regained 20/25 visual acuity, and IOP is 17 mm Hg to 18 mm Hg with topical beta blockers. The aesthetic effect is very good.

The drawback of the ArtificialIris is the cost, which is around $5,000 and is not reimbursed, Budo said.

This was a reasonably good ending for the devastating outcomes of an angle-supported IOL, “something we should not be seeing in our days,” Budo said. – by Michela Cimberle

For more information:

Camille Budo, MD, can be reached at Centre d’Ophthalmologie, Rue Bellaire 18B, 4120 Rotheux-Rimière, Neupré, Belgium; email: camille.budo@gmail.com.

Disclosure: Budo reports no relevant financial disclosures.